No fault compensation for accidental injury.

The numbers of claims for medical mishap has increased dramatically in recent years and the total amount paid annually to successful claimants has increased at least tenfold in the last fifteen years. No-one will dispute that high standards of care should be encouraged and basic minima enforced, but the present situation ultimately benefits only the lawyers. It has been projected that, if the present trend continues , the annual subscription to our medical defence societies (currently ?336) will rise to ?1000 within the next three years. Health authorities, unable to insure against medical mishap must pay lost suits from current revenue. It is not uncommon for awards to exceed ?500,000 with costs.

often not communicated by the doctor and/or ade- quately perceived by the patient.
3. The patient's sense of a doctor's infallibility may be a required part of the healing process. 4. The person seeking medical care is, by definition, in a vulnerable state.Once 'something has gone wrong' the anger and grief of the patient or his family can produce a need to find fault. 5.The anatomy of medical mishap is complex.Hushed voices at the end of the bed or lack of clear and concise information, which may be due to uncertainty among doctors or nurses, are perceived as conspiracy by the aggrieved. 6.In cases which involve handicapped children (the area of primary interest to the Spastics Society), argu- ments on causation are often based on flimsy and simplistic evidence.Doctors are unwilling to admit (and patients refuse to accept) that they 'do not know'.

The Extent of the Problem
The problem is much bigger than is generally acknow- ledged.Statistics are kept by the medical defence societies but are not divulged.It is known that in 1981 700 legally aided writs were served for medical negli- gence and it is likely that that number has increased at least four-fold since then.The number of cases being brought in relation to perinatal brain damage has in- creased dramatically in recent years.
In an estimated 70% to 80% of cases the patient or his family are not seeking damages but satisfaction and information.They want to see that 'the same thing does not happen again'.In approximately 20% to 25% of cases the negligence is clear.Only a tiny minority of all claims (ca 1%) are fought out in court.
The Patient's Viewpoint Those injured by medical mishap face many problems in pursuing any action, however justified.Among them are: 1.The cost involved?onlythe incredibly wealthy or those assisted by legal aid can afford it. 2. Finding an experienced lawyer?thepatient is likely to approach the lawyer who, for example, helped with house purchase.Such 'general practitioner' lawyers are inexperienced in medical negligence cases and are, therefore, at a disadvantage compared to the experts used by the medical defence societies. 3. Finding a medical expert to prepare a report?somemembers of the medical profession feel that it is 'not quite the done thing' to act on behalf of the plaintiff.The call on the time of those willing to do so in pre-trial preparations and particularly in court is so great as to be a severe disincentive.
4. The length of time before settlement?the case can drag on for many years.This is sometimes due to stalling by health authorities (it is amazing how often the plaintiff's case-notes are inexplicably lost for several years) or others, but can be due to the time taken before the full nature of residual damage can be assessed.
The effect of continuing as we are Although some believe that 'patients are turning against the profession', this is not generally accepted.The nature of the 'social contract' is, however, changing. (For discus- sion of this, see Editorial, J. Med. Ethics. 1985,11, 59-60).
As a result the practice of 'defensive medicine' is increas- ing.This has 'knock-on costs' which can be serious; for example, the increasing recourse to caesarean section, in the unproven belief that it is safer for the child, produces greater risk of morbidity and mortality to the mother without necessarily reducing the incidence of cerebral palsy in the offspring.
Although we are told that 'our view should not be clouded by the American scene' this is the spectre which is in the minds of many in the medical profession.
Rumours of differential subscriptions to medical defence societies for doctors in 'high risk' specialties, e.g.obstet- rics, orthopaedics, neonatology and neuro-surgery, has fuelled these fears.In the interests of all concerned, every effort should be made to prevent the growth in adversarial litigation.Any alternative needs to provide information on causation and a decision on compensa- tion.The initial effort should be concentrated on changing attitudes within the medical profession.